Susan Bradley
Back to MSc Alumni
Country: England
Background:
Research Project: Mid-Level providers in emergency obstetric and newborn health care: factors affecting their performance and retention within the Malawian health system
BACKGROUND: Malawi has a chronic shortage of human resources for health. This has a significant impact on maternal health, with mortality rates among the highest in the world. Mid-level cadres of health worker provide the bulk of emergency obstetric and neonatal care. Whilst there have been several studies addressing retention factors for medical doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce.
METHODOLOGY: This exploratory qualitative study took place over a 2-week period in four rural Christian Health Association of Malawi hospitals. The study population were mid-level providers of emergency obstetric and neonatal care. Focus group discussions took place with nursing and medical cadres. Semi-structured interviews with key human resource, training and administrative personnel were used to provide context and background. Data were analysed using a framework analysis.
RESULTS: Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. The main factors impacting on retention and performance were insufficient financial remuneration, limited opportunities for career development and further education (particularly for clinical officers), and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly de-motivating.
CONCLUSION: Mid-level cadres are being used to stem Africa’s brain drain. It is in the interests of both governmental and CHAM to protect their investment in these workers. For optimal performance and quality of care they need to be supported and properly motivated. A structured system of continuing professional development and functioning human resources management would show commitment to these cadres and support them as professionals. Action needs to be taken to prevent staff leaving the health sector for less stressful, more financially rewarding alternatives.